Cholesterol is needed for normal cell membrane function and as a precursor to steroid hormones, bile acids, and vitamin D. Metabolism of cholesterol, which is both produced in the liver and obtained through diet, is carefully controlled in the body. In some circumstances, however, cholesterol metabolism becomes dysregulated, leading to high blood cholesterol levels, accumulation of cholesterol in tissues and immune cells, and increased risk of atherosclerosis and heart disease.1
Cholesterol circulates in several types of fatty complexes, which have different effects on vascular health and function. In simplest terms: very low-density lipoprotein (VLDL)-cholesterol is made in the liver and released into the bloodstream; VLDL is converted into low-density lipoprotein (LDL)-cholesterol, which delivers cholesterol to tissues and cells, promoting atherosclerotic plaque formation; high-density lipoprotein (HDL)-cholesterol retrieves excess cholesterol from circulation and from cells in the blood vessel lining and returns it to the liver for storage or excretion, possibly inhibiting plaque formation. The amounts of total cholesterol and each type of cholesterol are measured to assess cardiovascular risk. High levels of VLDL- and LDL-cholesterol (sometimes referred to as non-HDL cholesterol) and low levels of HDL-cholesterol are associated with heart disease.2, 3 Importantly, while LDL-cholesterol-lowering therapies have been shown to reduce cardiovascular events (like heart attack and stroke), therapies that raise HDL-cholesterol levels have so far failed to improve cardiovascular outcomes.4
The American Heart Association recommends total cholesterol levels should stay under 200 mg/dL, although the optimal level is likely to be closer to 150 mg/dL.5 They also recommend a target LDL-cholesterol level of 100 mg/dL or lower, and a target HDL-cholesterol level of 60 mg/dL or higher. Target cholesterol levels in individuals with a high cardiovascular risk or a history of a cardiovascular event, such as known cardiovascular disease, diabetes, or a previous heart attack, are more stringent, especially regarding LDL-cholesterol.6, 7 Healthy cholesterol levels, however, are not a guarantee of good heart health, as some people with lipid profiles considered to be healthy can still have atherosclerosis and an increased risk of heart attack.8, 9
The following discussion is limited to information about improving cholesterol levels using natural approaches. People with high cholesterol levels may also want to learn more about atherosclerosis and cardiovascular disease.
The body’s circadian clock plays a critical role in regulating metabolism, and disruption of natural rhythms has been associated with high cholesterol levels and other signs of poor metabolic health.10 Shift work and other causes of short nighttime sleep, as well as variability in sleep and activity patterns from day to day, have been found to correlate with higher cholesterol levels.11, 12 Observational evidence indicates those with a preference for evening activity, including eating, have worse metabolic health, including higher cholesterol levels.13, 14, 15
Compared with those who routinely skip breakfast, habitual breakfast eaters have been noted to have better lipid profiles and lower cardiovascular risk.16 In a crossover-design clinical trial, 12 healthy participants ate a controlled diet comprised of three meals and two snacks during two eight-week phases: in the first phase, eating was restricted to the hours of 8AM–7PM, but in the second phase, eating was delayed until noon and ended at 11PM. A number of other metabolic markers, including total cholesterol levels, improved after the daytime eating phase and worsened during the delayed eating phase of the trial.17 In addition, a habit of eating smaller amounts more frequently during the day has been associated with lower cholesterol levels.18
Exercise and a physically active lifestyle have been found in multiple randomized controlled trials to increase protective HDL-cholesterol while decreasing heart disease-related triglyceride, LDL-cholesterol, and total cholesterol levels.19, 20 Even low-intensity exercise such as walking and Tai Chi can raise HDL-cholesterol levels, while more rigorous exercise may be needed to lower LDL-cholesterol levels.21, 22, 23 Importantly, weight gain appears to nullify the positive effects of exercise on lipid levels.24 Some evidence suggests evening exercise is more effective than morning exercise for improving cholesterol levels.25 Physical activity has the additional advantage of lowering risks of heart disease, type 2 diabetes, depression, anxiety, cancer, and myriad other chronic conditions.26
Smoking impairs lipid metabolism and is linked to increased total, LDL-, and non-HDL-cholesterol levels, as well as lower HDL-cholesterol levels. Even secondhand smoke exposure has negative impacts on cholesterol levels, especially in children.27 Furthermore, smoking is a major contributor to heart disease. Quitting smoking can result in improvement in lipid levels and is an important strategy for decreasing cardiovascular risk in people with high cholesterol levels.28
Psychological factors such as anxiety, depression, distress, anger, and hostility have been shown to contribute to heart disease risk in both men and women.29 On the other hand, optimism, conscientiousness, openness to experience, and curiosity have been found to reduce cardiovascular risk.30 Some, but not all, research indicates yoga and mindfulness may improve markers of cardiovascular health, including cholesterol levels.31, 32, 33
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The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2024.